Provider Demographics
NPI:1619921350
Name:DAY, CAROLYN K (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:K
Last Name:DAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-0670
Mailing Address - Country:US
Mailing Address - Phone:541-389-7741
Mailing Address - Fax:541-278-8376
Practice Address - Street 1:2175 NW SHEVLIN PARK RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7101
Practice Address - Country:US
Practice Address - Phone:541-389-7741
Practice Address - Fax:541-278-8376
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD167095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8348989Medicaid
WAAB33689OtherMEDICARE RHC
WA8348989Medicaid
WA8348989Medicaid